Individual
BOBBY LEE BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADC-1, CRM, QMHA-R
Contact information
Practice address
3647 HIGHWAY 39, KLAMATH FALLS, OR 97603-2612
(541) 884-5244
Mailing address
3647 HIGHWAY 39, KLAMATH FALLS, OR 97603-2612
(541) 884-5244
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
175T00000X
Peer Specialist
—
—
Other
Enumeration date
07/20/2020
Last updated
05/08/2024
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